Dear Dr. Roach: I know a successful career woman, a psychologist working for the school board and a private practice as well, who has recently been admitted to a psychiatric hospital.
She has never had an addiction to any type of drugs or alcohol, has never been suicidal or even shown any suicidal ideation, has diligently put together a lucrative retirement package for herself, has never been diagnosed with any mental health afflictions or had any personality-altering brain injuries.
I talked to her just a few days before she was admitted. We had a typical, normal conversation with no hint of anything unusual about her.
My question is, why was she involuntarily committed? Her friend, another psychologist she’d been friendly with for decades, advised it, saying she was “manic.” Her friend claimed that she had called out of work for several days, cancelled on patients and was “not making sense” while they spoke on the phone the day before. Her brother, a retired physician whom she’s always had some measure of a decent relationship with, agreed. She apparently required eight people to bring her in when she was involuntarily admitted.
G.Q.
Sudden alterations in a person’s thinking are scary and very disturbing, so I understand your concern.
Taking away a person’s liberty via an involuntary admission to a psychiatric hospital is taken extremely seriously by the state, not least of which because there have been many abuses of this in the past. The absolutely necessary criteria are (quoting from the state law where this happened) that the “person has a mental illness for which care and treatment in a mental hospital is essential to his/her welfare; [the] person’s judgment is too impaired for him/her to understand the need for such care and treatment; [or] as a result of his/her mental illness, the person poses a substantial threat of harm to self or others.”
There are several psychiatric conditions that may lead to involuntary admission. Suicidal depression is one. Depression is occasionally accompanied by an acute psychosis (“psychosis” means a grossly distorted sense of reality). Psychosis is more commonly caused by bipolar disorder or schizophrenia, either of which could be the diagnosis for your friend. “Mania” is a specific syndrome of activity associated with bipolar disorder, which her psychologist friend was concerned about. There is also an uncommon syndrome called brief psychotic disorder, with a very abrupt onset and duration.
These psychiatric terms, especially mania, schizophrenia and psychosis, have specific meanings in medicine and are commonly misused, often pejoratively, by laypeople.
Drug intoxication from prescription or recreational drugs can be difficult to tell with a psychiatric illness (and the two often coexist). Days or even weeks are generally required to determine the underlying psychiatric cause with any certainty. There are medical illnesses that can mimic psychosis, and internal medicine doctors and neurologists are often consulted to help evaluate for these.
The amount of time your friend can be involuntarily held without a court order depends on the exact circumstances of her admission, but cannot exceed 60 days. Your friend (or her agent) can request a court hearing to apply to be released, which must be held within five days of receipt.
I don’t have enough information to make a guess at her underlying diagnosis, but her psychologist friend who observed mania makes bipolar disease likely, even if the onset was very sudden.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
